江西省人民医院于2021年10月17日收治1例69岁男性“胸腔积液、肺部感染”患者,患者诉右侧肋弓部疼痛7 d,有牙周病病史及脑梗死个人史。入院后查体：右侧胸部叩诊呈浊音,右肺呼吸音未及,左肺可闻及干啰音。胸部彩超提示双侧胸腔积液;胸部X光和CT检查提示右侧胸腔积液,右肺感染;胸水涂片和瑞氏-吉氏染色涂片查见滴虫;胸水高通量测序结果为口腔毛滴虫。结合患者病史及辅助检查结果,诊断为口腔毛滴虫感染、肺部感染。住院期间予患者胸腔闭式引流,甲硝唑、奥硝唑静脉输液（0.5 g/次,2次/d）及胸腔内注射（0.5 g/次,1次/d）共治疗14 d,同时联合哌拉西林他唑巴坦（4.5 g/次,3次/d）抗感染治疗23 d,分别于10月30日、10月31日、11月2日胸腔内注射尿激酶（20万单位/次）消除胸膜腔分隔,治疗后患者症状好转,复查胸水未见滴虫,胸部CT提示胸腔积液较前减少,余无特殊异常遂出院。出院1月后复诊,患者无特殊不适,行胸部CT检查未见胸腔积液,余无明显异常。

A 69-year-old male patient with pleural effusion and pulmonary infection was treated in Jiangxi Provincial people’s Hospital on October 17th, 2021. The patient complained of pain in the right costal arch for 7 days, with a history of periodontal disease and a personal history of cerebral infarction. Physical examination upon admission showed dullness on percussion at the right chest, the right lung breath sound was not heard, and dry rales could be heard in the left lung. Chest Color Doppler Ultrasound revealed bilateral pleural effusion; chest X-ray and CT showed right pleural effusion and right lung infection. Trichomonas could be seen in hydrothorax smear and Wright-Gibbs smear. High-throughput sequencing of pleural effusion showed Trichomonas oralis. Combined with the patient’s history and auxiliary examination results, the diagnosis was oral Trichomonas infection and pulmonary infection. During hospitalization, patients were given closed thoracic drainage, intravenous infusion of metronidazole and ornidazole (0.5 g/once, twice a day) and intrapleural injection of metronidazole and ornidazole (0.5 g/once, once a day) for 14 days combined with piperacillin tazobactam (4.5 g/once, 3 times a day) for 23 days, and urokinase (200 000 units/time) on October 30th and October 31st, respectively. After three times of intrapleural injections to eliminate pleural separation on November 2nd, the patient’s symptoms improved and no trichomonas was found in pleural effusion. Chest CT indicated that the pleural effusion was significantly improved, and the patient was discharged without additional abnormality. One month after discharge, the patient had no discomfort, no pleural effusion and no obvious abnormality were found by chest CT examination.